Semmelweis Egyetem
Dr. G
Summary
The most effective method of treating terminal kidney diseases is kidney transplantation. However, the number of cadaver donors does not grow with the number of patients suffering from end-stage kidney failure. Introducing living-donor kidney transplantation proved to be an effective way of increasing the number of donors. A preliminary examination of the anatomy of renal vessels is essential to reduce the potential complications of hand-assisted laparoscopic donor nephrectomy.
Being aware of the embryological development of the arterial and venous system may provide an in-depth understanding of the versatility of the variations. Our research seeks to answer the following questions: to what extent anatomical and other morphological features discovered via multidetector-row CT (MDCTA) examinations influence the choice between the donor kidneys, and whether a simplification of the anatomical description could make the process more effective.
We have analysed MDCTA examinations of 55 donors between 27 and 78 years of age.
We have pinpointed the arterial and venous variations we have found, we have surveyed them through radiologist-surgeon consultations, and validated the results after the surgery. With 67% (37/55) of the 55 donors we have found certain vascular variations in the transplanted organ. In 70% of the above cases (26/55) one such variation was discovered both on the preoperative CT images and during the surgery, while in 22% of the cases (26/55) two and in 8% (3/55) of the cases three variations have been identified. In the cases of the above 37 donors we have found 51 vascular variations altogether that were also validated during surgeries later on.
Based on the results of our research (1) the MDCTA examination proved to be an excellent method to map the renal vascular variations; (2) the changes we have implemented in the terminological system further clarified the anatomic situation which in turn facilitated the surgeon-radiologist consultations; (3) we have systematized the vascular variations; (4) and expressed our opinion concerning the anatomical variations and their significance with regard to the surgery.
A ja a betegek
A Az illetve
krek, rokon vagy
- is.
obb,
-
-
-
graft-
haladja meg a 90
-
a cadaver-
- -
- m csak a recipiens
-
A a fentiek
.
A -
ikreken a Pet
L
Inderbir -ben , nem -
ben Lloyd Ratner embe
A
e
. Az
-ben. A Semmelweis Egyetem Transzplan -
cadaver vese TX (db)
(db)
2000 144 140 4 2,8
2001 148 141 7 4,7
2002 183 177 6 3,3
2003 175 171 4 2,3
2004 156 148 8 5,1
2005 177 164 13 7,3
2006 161 154 7 4,3
2007 159 148 11 6,9
2008 157 141 16 10,2
2009 163 148 15 9,2
2010 156 125 31 19,9
a erete . A
multidetektoros CT (MDCT)
tanyagos CT
gy nyert
seg
kell dolgoznia. Az o
-
,
, de a
.
z MDCT esetleges
ba ,
.
el Abban a
1) A -
re?
2) -e -
renalis
4) Milyen, MDCT-
oldali ?
Alanyok
A d . .
za fel
ada
) az
2 volt. A donorok 91%-a rokon, 9%- volt. A
szer
z
A mu
M -
Brilliance 190 P; Philips Healthcare Systems)
orozat a
-
1,3-szorosa volt.
kontrasztanyagok Iomeron 400 (iomeprol, Bracco UK Ltd.), Ultravist 370 (iopromid,
-
spina iliaca anterior superior szi
rendszert.
-
ok elemz
szakorv
volu
-
ek a
megszokott n
jobb ve
iszonyokat.
ereket.
:
konszenzus e tekintetben -
lop
val
v
-ba
jelz
-
R
-hoz.
l.
Bal oldalon amelyek a
J
t
A multidetektoros CT
- -
MDCTA lelet
TN FN
FP TP
2.
TN (true negative)
FN (false negativ)
TP (true positive)
= TP/(TP+FN) = TN/(TN+FP)
= (TP+TN)/(TP+TN+FP+FN) = TP/(TP+FP)
= TN/(TN+FN)
A 2008. .
A f
-
meg.
-
-
-a (37/55) rendelkezett valamilyen, a
- -
- -ban (3/55) alkalommal
b, a -
-
. -
volt.
Donor MLRA (No.) MRRA (No.) MRRV (No.) CAV RAV LV
1 X (2) X
2 X (4)
3 X (2) X (2) X X
4 X (2) X
5 X (2) X (2) X
6 X (2)
7 X (3) X (2) X
8 X (3) X (2)
9 X X
10 X (2) X
11 X (2) X X
12 X (2) X (2) X X
13 X X
3.
-
TN 18 18 18
FN 0 1 1
TP 17 34 51
100% 97% 98%
95% 100% 95%
97% 98% 97%
d 94% 100% 98%
100% 95% 95%
5
1) az
a vese vascula
2) az a a
-
-
Deak PA, Doros A, Lovro Z, Juhasz E, Branstetter G, Kovacs JB, Piros L, Jaray J Significance and Imaging of Lumbar Veins and Early-Branching Arteries in Planning Living-Donor Laparoscopic Nephrectomy: Two Case Reports From 21 Months' Experience. TRANSPLANTATION PROCEEDINGS 42:(6) pp. 2347-2349. (2010) IF:
0.993
Deak PA, Doros A, Lovro Z, Toronyi E, Kovacs JB, Vegso G, Piros L, Toth S, Langer RM. The Significance of the Circumaortic Left Renal Vein and Other Venous Variations in Laparoscopic Living Donor Nephrectomies. TRANSPLANTATION PROCEEDINGS 43:(4) pp. 1230-1232. (2011) IF: 0.993
Vegso G, Toronyi E, Hajdu M, Piros L, Gorog D, Deak PA, Doros A, Peter A, Langer RM. Renal Cell Carcinoma of the Native Kidney: A Frequent Tumor After Kidney Transplantation With Favorable Prognosis in Case of Early Diagnosis.
TRANSPLANTATION PROCEEDINGS 43:(4) pp. 1261-1263. (2011) IF: 0.993
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Zadori G, Gelley F, Torzsok P, Sarvary E, Doros A, Deak PA, Nagy P, Schaff Z, Kiss A, Nemes B. (2011) Examination of Claudin-1 Expression in Patients Undergoing Liver Transplantation Owing to Hepatitis C Virus Cirrhosis. Transplant. Proc., 43:
1267-1271.
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83: 8-13.
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- Orvosi Hetilap 150: 1231-1234.
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& Applied Science 1: 41-45.
(2010) Treatment of early hepatic artery complications after adult liver transplantation : A single center experience. Interventional Medicine & Applied Science 2: 159-164.
(2010) Radiofrequency ablation of an intercalyceal neoplasm in a transplanted kidney using percutaneous nephrostomy for cooling. Safety and early result. Interventional Medicine & Applied Science 2: 37-41.
(2010) Successful urinary tract reconstruction following ureteral necrosis in kidney transplant patient. Interventional Medicine & Applied Science 2: 134-138.
,
(2007) Are metallic biliary stents feasible in treatment of post- transplant biliary stenosis: Long term follow up. Transplant International 20: 301.
